氧化氮-环磷酸鸟苷通路在支气管哮喘发病机制中的作用

目的 :探讨一氧化氮 -环磷酸鸟苷 (NO- c GMP)通路在支气管哮喘发病机制中的作用。方法 :给 10名健康人、13例缓解期哮喘病人及 2 9例发作期哮喘患者诱导痰液 ,检测诱导痰液中 NO2 - /NO3- 及 c GMP的水平。并对其中 11例哮喘发作期患者应用强的松 (30 mg/d) ,治疗 1周的前后进行自身对照研究。结果 :哮喘发作期患者 NO2 - /NO3-水平显著高于健康对照者 [(4 0 6 .34± 5 12 .18) μmol/L,(71.80± 10 0 .98) μmol/L,P<0 .0 1],应用激素后患者在症状、体征好转的同时 ,NO2 - /NO3-和 c GMP的水平均有明显下降 ,稳定期哮喘患者的 NO2 - /NO3-水平同正常人相比差异无显著性。结论 :NO- c GMP通路可能在哮喘的发病中起重要作用 ,诱导痰 NO2 - /NO3- 的测定是无创伤性检测哮喘气道炎症的一项简便易行的实用方法。     

Apnoeic oxygenation in paediatric anaesthesia: a narrative review

Apnoeic oxygenation refers to oxygenation in the absence of any patient or ventilator effort to move the lungs. This phenomenon was first described in humans in the mid-20th century but has seen renewed interest in the last decade following the demonstration of apnoeic oxygenation with low-flow, and subsequently high-flow, nasal oxygen. This narrative review summarises our understanding of apnoeic oxygenation in the paediatric population. We examine the evidence supporting oxygenation via tracheal tube, modified laryngoscopes and nasal cannulae. The evidence for prolongation of safe apnoea time at induction of anaesthesia is also appraised. We explore the capacity for carbon dioxide clearance, flow rate selection with high-flow nasal oxygen and complications associated with the technique. It remains uncertain whether apnoeic oxygenation in paediatric patients results in a meaningful clinical benefit compared with standard care for outcomes such as the number of tracheal intubation attempts or the incidence of hypoxaemia. In particular, the role of apnoeic oxygenation in paediatric difficult airway management is unclear as this has not been the targeted focus of any published research to date.     

迪利单抗对肺癌患者嗜酸性气道炎症的研究

目的 探讨信迪利单抗对肺癌患者嗜酸性气道炎症的影响。方法 选取2019年4月—2020年4月于徐州医科大学附属宿迁医院就诊的60例IV期非鳞非小细胞肺癌患者,随机分为对照组(单纯化疗组)和试验组(信迪利单抗联合化疗组);对照组给予培美曲塞500 mg/m2联合顺铂75 mg/m2静脉注射;试验组在对照组治疗方案基础上联合免疫检查点抑制剂信迪利单抗200 mg静脉注射,均21天为1个周期。6个周期治疗后检测两组患者呼出气一氧化氮(Fractional exhaled nitric oxide,FeNO)、外周血嗜酸性粒细胞计数、肺功能及动脉血气;分析信迪利单抗治疗组严重不良事件(SAE)及免疫相关性肺炎(CIP)的发生率。结果 ⑴试验组在第2、4、6周期治疗后FeNO水平、外周血嗜酸性粒细胞计数相较于基线水平出现升高趋势,但差异无统计学意义(PFeNO=0.536; PEos=0.762)。⑵两组患者经6个周期治疗后,第1秒用力呼吸容积(FEV1)、用力肺活量(FVC)、FEV1/FVC、一氧化碳弥散量占预计值百分比(DLco%)较治疗前均无明显变化(PFEV1=0.615; PFVC=0.473; PFEV1/FVC=0.637; PDLco%=0.598);动脉血气分析中PH、PaO2、PaCO2水平较治疗前均无明显变化(PPH=0.457; PPaCO2=0.242; PPaO2=0.631)。⑶试验组免疫相关SAE发生率和CIP的发生率均为0。结论 6周期治疗后信迪利单抗对肺癌患者的嗜酸性气道炎症、肺功能、动脉血气分析无明显影响,未出现免疫相关SAE及CIP。     

人体呼吸道的二级及三级支气管内吸气流动的数值研究

呼吸系统的主要生理机能是在大气和血液之间交换氧气和二氧化碳，其生理过程与呼吸道内的气体流动和输送有密切关系。本文利用数值模拟方法对呼吸道内二级及三级支气管模型内的吸气过程进行数值研究，研究表明：二级支气管的计算结果与现有的实验值吻合很好；在三级支气管内。当人体处于正常吸气流量下，支气管内未发生任何分离现象。但流道几何形状的弯曲和分岔使支气管内出现强烈的二次流现象，主流速度出现倾斜分布及m-型分布特征。从而加大了分岔管内侧壁面及前后侧壁面上的切应力；在三级支气管的末级管内，流量分流不均匀。在计算条件下，中部支气管内的流量与侧部支气管内的流量之比为1．2。     

Bronchoconstriction of the asthmatic airway by inhaled and ingested propranolol

Summary Responsiveness to inhaled histamine and DL propranolol hydrochloride was measured in 31 adult asthmatics and compared with bronchoconstriction provoked by acute oral propranolol dosing (max 160 mg).Twelve asthmatics developed 15% reduction in the forced expired volume in 1 s (FEV₁), 2 h after 100 mg oral propranolol; cardiac -adrenoceptor blockade was confirmed by cycle exercise tests in the 19 without airway response. The provocative inhaled dose of each aerosol causing a 20% fall in FEV₁ (PC₂₀) was lower, histamine 0.43 mg·ml^–1, propranolol 3.12 mg·ml^–1, in the 12 with a positive oral test compared with the 19 with a negative test, PC₂₀ histamine 1.65 mg·ml^–1, PC₂₀ propranolol 16.2 mg·ml^–1 (P < 0.001 for both aerosols). A correlation was demonstrated between the PC₂₀ values for asthmatics with a negative oral test (r=0.72, P < 0.001, n=19) but not for the remainder (r=0.14, P > 0.05, n=12).Plasma propranolol concentrations (CL, ng·ml^–1) after the final oral dose did not correlate with the % FEV₁(26.3) (r=-0.28) when an airway response was provoked or with the reduction in exercise tachycardia (25.9%) (r=0.31) when no bronchoconstriction occurred. CL exceeded the limit of detection after the final inhaled propranolol dose (7.5 ng·ml^–1) and was weakly related to the PC₂₀ propranolol value (r=0.53, P=0.01, n=27). The prevalence of a positive oral challenge was low in this group (39%). APC₂₀ propranolol value which was 100% sensitive as a predictor of a positive oral test had low specificity (58%) and a low predictive value (60%).This study has not found that nonspecific bronchial responsiveness to histamine or specific responsiveness to inhaled propranolol can be employed to predict bronchoconstriction in asthmatics following acute oral propranolol dosing.     

Intratracheal administration of recombinant adenovirus containing IL-18 gene in treatment of experimental metastatic lung carcinoma

Objective: To study the treatment of experimental metastatic lung carcinoma by intratracheal injection of IL-18 gene recombinant adenovirus. Methods: (1)The mouse IL-18 mRNA was detected by RT-PCR, and the concentration of 1L-18 and associated cytokines in lung lavages and blood were determined by ELISA at different time points after intratracheal injection of IL-18 recombinant adenovirus. (2)The lung metastasis nodes, mouse survival periods and survival rates were evaluated. NK activity and CTL activity were determined by 51Cr 4 h release method. Results: (1)IL-18 mRNA was detectable in lung tissue 6 h after intratracheal use of IL-18 recombinant adenovirus, and the concentration of IL-18 in lung lavage was higher than that in peripheral blood. Neither IL-18 mRNA nor IL-18 was detectable in control group. (2) Intmtmcheal use of IL-18 recombinant adenovirus resulted in increased CTL and NK activity, longer survival time and higher survival rates compared with the control group, showing significant therapeutic effect on experimental lung metastasis. Conclusion: Intratracheal use of adenovirus vector containing IL-18 gene has therapeutic effect on the lung metastasis, denoting that gene therapy of lung diseases could be applied through airway directly with recombinant adenovirus.     

原癌基因表达在哮喘气道重塑中的作用

目的观察原癌基因表达在哮喘气道重逆中的作用。方法卵蛋白致敏豚鼠 建立哮喘模型。Dot-blot,North-ern-blot分子杂交及免疫组织化学技术观察豚鼠气道上皮,肺组织中原癌基因c-fos,c-myc,c-jun和c-sis的表达及其与气道重塑的关系。结果：正常豚鼠气道及肺组织中c-fos和c-myc mRNA无或很少表达,哮喘发作后,豚鼠气道上皮及肺组织c-fos和c-mycmRNA的表达明显增加;免疫组织化学染色显示Fos,Myc,Jun及Sis在政党豚鼠低水平表达,4种原癌基因产物表达增,国,阳性反应细胞主要分布于气道上皮细胞胞质、气道及细支气的上皮细胞胞核及浸润的炎症细胞中,病理结果显示气道粘膜及小鼠气管平滑肌周围淋巴细胞、嗜酸性粒细胞及中性粒细胞浸润,气道平滑肌显著增生,结论原部达在气道重逆过程中有重要作用。     

喉癌下咽癌TGFβ1、p16表达的意义

目的 :通过对喉癌、下咽癌组织中转化生长因子 β1(TGFβ1)及 p16蛋白的定位、半定量研究 ,探讨其在喉癌、下咽癌组织中的表达与意义。方法 :采用SABC免疫组化法研究TGFβ1与 p16蛋白的表达 ,并对表达结果进行统计分析。结果 :TGFβ1位于胞浆 /胞膜 ,p16蛋白位于胞浆 /胞核。TGFβ1强表达率为61% ,p16蛋白强表达率为 66%。高分化与中、低分化肿瘤的TGFβ1表达均有统计学差异 (P <0 .0 5) ;高分化与低分化肿瘤的 p16蛋白表达具统计学差异 (P <0 .0 5)。TGFβ1和 p16蛋白之间存在正相关系 (P <0 .0 5)。TGFβ1和 p16蛋白的表达与患者年龄、性别、肿瘤生长部位、病程、临床分期无明显相关。 结论 :TGFβ1与 p16蛋白在喉癌、下咽癌中存在缺失表达 ,在高分化肿瘤中有更高的表达 ,在细胞周期中具有共同的作用。     

咽丛神经切断术在发音重建中的作用

目的　为解除咽缩肌的痉挛 ,提高喉全切除术后用发音管发音重建的成功率。方法　在一侧舌骨大角后内侧咽缩肌的后表面 6 5mm左右 ,可找到咽丛神经支配咽下缩肌的主支或分支 ,将其切断。结果　 16例中 15例咽丛神经切断术后发音重建成功 ,成功率为 93 8%。结论　咽丛神经切断术取代咽缩肌切断术是可行的。咽丛神经切断术能提高Blom Singer发音管发音重建的成功率 ,值得推广应用。